Every four years in June a peculiar epidemic bursts into the worldview. Healthy young men, most with an elite level of physical fitness, are suddenly stricken down. The victims drop to the ground at the slightest hint of physical contact and proceed to roll around, hands clamped to their faces as if mourning the death of a loved one. In many cases, bucket stretchers are raced onto the scene and the once-spry young men are hauled off like corpses to the morgue.

Thankfully, this horrible condition is fleeting; upon reaching the perimeter of the milieu, the ill are miraculously cured! They pop off the stretcher and sprint back to their comrades, as right as rain.

Does this floppy disease and its treatment seem as odd to you as it does to me? If the answer is "Yes," you may be surprised by the parallel that exists between World Cup soccer and current Emergency Medical Services (EMS) practice.

The paramedics have done their job and done exactly what they were trained to do, but have they done you any good?

Did you know that for approximately 50 years, the training and culture of our pre-hospital providers has resulted in millions of people being unnecessarily strapped and taped down to hard plastic boards without the freedom of movement for — at its worst — hours at a time? The practice is called spinal motion restriction and in most locales it remains standard. And, while in cases of severe spinal trauma such restriction can prevent injury progression, in other situations the use of backboards can be painful and even harmful.

Imagine that you've been in a fender bender on the freeway. The police and paramedics have been called. You've escaped your battered vehicle and walked away from it in dismay. Your neck is a tad sore from whiplash, and when asked, you tell this to the paramedics who are evaluating you. Next thing you know, you are pinned, supine, to a hard board, with a stiff collar around your neck. Your head is taped down and there are straps impinging your chest. You will stay this way until someone at the Emergency Department frees you.

The paramedics have done their job and done exactly what they were trained to do, but have they done you any good? Almost certainly not, and it turns out, there is virtually no evidence to support their actions. Spinal immobilization (or as it's more properly called "spinal motion restriction") began in the 1960s based on a couple of editorial-type papers and has continued since such that nearly 5 million patients are bound to backboards in the U.S. every year! Of these, only about 1 percent will actually have any sort of serious spinal injury, and only a miniscule percentage of these will actually benefit from being on a backboard. Does this sound as silly as a stretcher for a perfectly uninjured soccer flopper? I think so, and considering the damage that a backboard can cause a person (picture your elderly mother tightly strapped to a hard surface for 30 minutes), Marin County EMS thinks it's worse than silly.

Which is why in Marin County we are following the lead of Alameda County and others and changing the way we use backboards for injured patients. Since July 1, a new Marin EMS protocol narrowed the criteria for using full spinal immobilization — backboards, straps and all. The intent is to recognize that such equipment can be harmful in some circumstances — causing pain, restricting breathing, and decreasing blood flow to the brain — and that it should only be used in circumstances where there is evidence of a spinal cord injury or when needed for extrication from a tricky location.

The implementation of a similar protocol in Alameda County in 2012 resulted in a 58 percent reduction in the use of backboards without any reported ill effects. Here in Marin, we are hoping for similar, if not even better, results.

According to Marin's EMS administrator Miles Julihn, "This revised practice by our paramedics will not only reduce unnecessary pain and suffering for many of our patients, but is also consistent with Marin County's EMS System intention to be on the leading edge of proving and improving new standards for patient care."

So, now that the EMS community is on its way to absolving an unnecessary treatment in cases of minor trauma or injury, can soccer do the same? There seem to be several possible solutions (including retrospective replay review and yellow card treatment), but I wonder if a soon-to-be archaic form of EMS torture might do the trick? Any soccer flopper who can't get up on his own should get a ride on a backboard complete with straps and a collar — a ride that takes him right on out of the stadium.

Dr. Dustin Ballard is an emergency physician at San Rafael Kaiser, and the medical director for Marin County Emergency Medical Services.